Predictors of willingness to undergo back surgery: a survey of Australian privately insured adults with chronic back pain

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OBJECTIVE: Spinal surgery rates in Australia continue to rise despite limited evidence for their effectiveness in managing uncomplicated chronic back pain. This study examined patient-level factors that influence willingness to undergo surgery, to informing future work promoting non-surgical care pathways. METHODS: We conducted a cross-sectional online survey in March 2025 of 152 pirivately insured Australian adults with chronic low back pain. Participants reported pain characteristics, functional interference, prior imaging, and pain-related beliefs (expectations of recovery, self-efficacy, and catastrophizing). Willingness to undergo spinal surgery within five years was assessed on a 5-point scale and dichotomised into "willing" (3-4) and "unwilling" (0-1); respondents answering "unsure" were excluded. Logistic regression examined predictors of willingness to consider surgery. RESULTS: Of 152 participants (mean age 59.3 years, 64% female), 24% expressed willingness to undergo surgery. Negative pain beliefs, higher pain intensity, and younger age significantly predicted willingness, with the strongest effect seen for negative pain beliefs (OR 2.62, 95% CI 1.16-5.92, p=0.02). Functional interference, imaging history, and gender showed positive but non-significant associations. CONCLUSION: Negative pain beliefs predict willingness to undergo spinal surgery. This finding has important policy implications, suggesting that addressing belief-driven demand may help reduce the economic burden of surgery by directing patients toward guideline-based, high-value non-surgical care.